Injectable freeze-dried chitosan-platelet-rich-plasma implants improve marrow-stimulated cartilage repair in a chronic-defect rabbit model

Bone-marrow stimulation (BMS) improves knee-joint function but elicits incomplete repair. Liquid chitosan (CS)-glycerol phosphate/blood clots have been shown to improve BMS-based cartilage repair. Platelet-rich-plasma (PRP)-a rich source of growth factors and cytokines-improves recruitment and chondrogenic potential of subchondral mesenchymal stem cells. We hypothesised that repair response in a rabbit chronic-defect model will improve when freeze-dried CS/PRP is used to augment BMS. Bilateral trochlear defects created in New Zealand white rabbits were allowed to progress to a chronic stage over 4 weeks. Chronic defects were debrided and treated by BMS in second surgery, then augmented with PRP (BMS + PRP) or freeze-dried CS/PRP implants (BMS + CS/PRP). The quality of 8-week repair tissue was assessed by macroscopic, histological, and micro computed tomography (Micro-CT) analysis. ICRS macroscopic scores indicated fibrocartilaginous or fibrous repair in control defects that were improved in the BMS + CS/PRP group. An overall improvement in repair in BMS + CS/PRP group was further confirmed by higher O'Driscoll scores, %Saf-O and %Coll-II values. Micro-CT analysis of subchondral bone indicated ongoing remodelling with repair still underway. Quality and quantity of cartilage repair was improved when freeze-dried CS/PRP implants were used to augment BMS in a chronic defect model.